Your Digest for Thursday, Mar 07, 2024 12:59 PM


Pompholyx

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Dishydrotic eczema
Precipitated by sweat - in high humidity conditions.
pruritic (intensely)
Small blisters
Management


Diagnosis of Diabetes mellitus

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[!TIP]Mnemonic: Seven - eleven
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HbA1C > 6.5% is diagnosis of DM.

HbA1C should be avoided in pregnancy, children, haemoglobinopathies, haemolytic anaemia, HIV, untreated iron deficiency anaemia. (due to high turnover)
Abnormally low HbA1c can be caused by deteriorating renal function and weight loss.


hashimotosMnemonic.pngRubberyGlandHashimotosMnemonic.png


📑Azathioprine


- Or with a *differentiating agent*. (**All trans retinoic acid**)
- has the t(15:17) translocation.

Background physiology of lymphocytes

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Source-YouTube
Source-YouTube
Source-YouTube

MHC I MHC II
Present on ALL nucleated cells Presenton APCs
Binds CD8 receptor Binds CD4 receptors
Stimultes Cytotoxic T cells Stimulates T helper cells

Natural killer cells

[!TIP] 2 minute summary: from MSD manuals
Chronic myeloid leukemia (CML) occurs when a pluripotent stem cell undergoes malignant transformation and clonal myeloproliferation, leading to a striking overproduction of mature and immature granulocytes. Initially asymptomatic, CML progression is insidious, with a nonspecific “benign” stage (malaise, anorexia, weight loss) eventually giving way to accelerated or blast phases with more ominous signs, such as splenomegaly, pallor, easy bruising and bleeding, fever, lymphadenopathy, and skin changes. Peripheral blood smear, bone marrow aspirate, and demonstration of the Philadelphia chromosome are diagnostic. Treatment is with tyrosine kinase inhibitors (TKI) such as imatinib, dasatinib, nilotinib, bosutinib, and ponatinib, which significantly improve response and prolong survival. Myelosuppressive drugs (eg, hydroxyurea), stem cell transplantation, and interferon alfa are also sometimes used.

| Polycythemia | ❗Anaemia - may be symptomatic | |
| | Lymphadenopathy - only in blast crisis | |
| ❗Trilineage hypercellularity | Bone marrow : increased cellularity | |
| Mx : Aspirin and phlebotomy | TKI - b / intenstive chemotherapy like AML if blast phase occurs | |

Chronic lymphocytic leukemia features

[!INFO] 2 minute summary from MSD manuals.
Chronic lymphocytic leukemia (CLL) is characterized by progressive accumulation of phenotypically mature malignant B lymphocytes. Primary sites of disease include peripheral blood, bone marrow, spleen, and lymph nodes. Symptoms and signs may be absent or may include lymphadenopathy, splenomegaly, hepatomegaly, fatigue, fevers, night sweats, unintentional weight loss, and early satiety. Diagnosis is by flow cytometry and immunophenotyping of peripheral blood. Treatment is delayed until symptoms develop and generally involves chemotherapy and immunotherapy. However, treatments are evolving, and first-line regimens may include targeted agents such as inhibitors of Bruton tyrosine kinase (Btk) and Bcl-2, with or without chemotherapy. CLL is considered incurable with current treatment.


Protozoan parasite.

The center of the spectrum consists of localized cutaneous leishmaniasis (LCL), which is the most common clinical presentation.
At the opposite end of the spectrum, diffuse cutaneous leishmaniasis (DCL) is caused by polyparasitic disease with a predominance of parasitized macrophages and no granulomatous inflammation.
This is the commonest form in Sri Lanka. Source
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Mnemonic for HLA types and associations

HLA-A3:
3 looks like E.
AE - haemochromatosis

HLA-B51 - (B52 was a bomber in WW2)
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diseases beging with B.
Behcet's disease

HLA-B27 - B 2 -> b is the second letter, A is the first leter.
All A's
Anki spondi
Arthrits - reactive and psoriatic
Anterior uveitis

HLA-DR2 (DR - doctor) 2 for two disease
Goodpasture
narcolepsy
(Good doctor is sleeping)

HLA-DR3 (3 looks like E)
Dry Eyes - Sjogrens - And everything starts with an S
Snakes - dermatitis herpetiformis (herpetologist - "herpet" means to do with snakes)
PBC - Seerrhosis

HLA-DR4
T1DM
Rheuamtoid arthritis (4 looks like A - RA -arthritis)

Glaucoma

Source Youtube
Managementof AACG - acetazolamid 500mg stat followed by pilocarpine
POAG - primary open angle glaucoma - associated with myopia (long eye ball) and not hypermetropia (short eye ball) like AACG.
Cup : Disk ratio > 0.7 is seen.
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